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Labor

Poster Session 2

(608) Fully quantitative numeric cervical softening device at 37 weeks: Information for labor management decision making?

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: To utilize a novel, fully quantitative cervical elastography system (FQ-CES) which numerically quantifies cervical stiffness to examine association with onset of labor and mode of delivery.  

Study Design: This is a prospective cohort study of pregnant patients who underwent FQ-CES in the 37th week of pregnancy at a routine prenatal visit. We invented FQ-CES, which modifies a transvaginal ultrasound probe to quantify both pressure applied and tissue deformation, thereby yielding a fully quantified strain-based elastography system that provides a numeric quantification (Young’s modulus) of cervical tissue stiffness.  This system is operator independent and can be compared across patients and within patients over time. Singleton pregnancies without indication for delivery at 37 weeks were enrolled and FQ-CES were obtained. Patients remained enrolled regardless of their eventual timing or indications for delivery. The primary outcomes were onset of labor (spontaneous-SOL or induced IOL) and mode of delivery. Young’s modulus was log transformed to achieve normality of distribution (logYM). The Wilcoxon rank sum test was performed to assess the tissue FQ-CES with type of labor and mode of delivery.

Results: Of 149 patients included, 56 (37.5%) had IOL and 94 (63.1%) had SOL. 132 (88.5%) had vaginal birth and 17(11.4%) had cesarean birth.  Cervical elastography at 37 weeks was not significantly different between  groups but was nominally  higher (indicating a firmer cervix) in those who underwent induction of labor that ended in cesarean delivery.

Conclusion: An operator-independent fully quantitative cervical elastography measurement at 37 weeks could be used to identify individuals at higher risk for cesarean birth and allow time to modify clinical care to optimize opportunity for vaginal delivery. Future intervention studies such as outpatient cervical ripening or modified inpatient ripening protocols based on cervical elastography measurement are warranted.